A number of developments make the formal specification of competences in CBT both timely and relevant, in particular the Improving Access to Psychological Therapies (IAPT) programme, the increasing focus on process and therapist variables in determining outcome, and the increasing diversity of CBT. This paper outlines the development of an evidence-based methodology for determining both a model and a framework for CBT competences, and considers issues related to the implementation of the framework.

This study investigated the relationship between attachment orientation in adult patients and the early therapeutic alliance. Attachment was measured by self-report following the first session of therapy. The alliance was studied using patient and therapist ratings of its quality and reports of ruptures following early sessions. The sample comprised 30 clinical psychology outpatients treated by 11 experienced therapists. Correlation and multiple regression statistics provided partial support for the hypothesized relationships between attachment orientation and reports of alliance quality and ruptures. In line with predictions, fearful attachment was associated with lower alliance ratings (significantly with patient ratings at sessions 3 and 5 and therapist ratings at session 2) and secure attachment was associated with higher alliance ratings (significantly with therapist ratings at session 5). Preoccupied attachment and dismissing attachment were associated with improvement in alliance ratings over time, although there was some question about the reliability of these findings. Additionally, the frequency of rupture reporting varied with attachment orientation. Preoccupied attachment was associated with more frequent reports of ruptures and dismissing attachment was associated with fewer reports of ruptures. Implications for clinical understanding and future research are discussed.

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The ubiquity of intervention-specific training in research contexts risks being overlooked when commissioning evidence-based therapies in routine practice. This has clear implications for the likely effectiveness of interventions. Greater consistency in the reporting of training in clinical trials may help to draw attention to the role of training and supervision in maximizing clinical outcomes.

This article is based on an exhaustive review of the psychotherapy outcomes literature, undertaken originally at the instigation of the UK Department of Health by Roth and Fonagy (Department of Health, 1995). We have recently updated this review (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Roth & Fonagy, 2004) and extended it to identify all studies of psychoanalytic psychotherapy. The usual methods for identifying studies were employed (Fonagy, Target, et al., 2002; Roth & Fonagy, in press). The key questions that should be asked of this literature given the current state of research in this area (also see Westen, Morrison, & Thompson-Brenner, 2004) are: Are there any disorders for which short-term psychodynamic psychotherapy (STPP) can be considered evidence-based, Are there any disorders for which STPP is uniquely effective as either the only evidence-based treatment or as a treatment that is more effective than alternatives, and Is there any evidence base for long-term psychodynamic psychotherapy (LTPP) either in terms of achieving effects not normally associated with short-term treatment or addressing problems that have not been addressed by STPP? In this context, short-term therapy is conceived of as a treatment of around 20 sessions delivered usually once weekly.